BackgroundSouth Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue.MethodsThe Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care.ResultsResponse rates ranged from 83% in the first round (n=44) to 64% in the final round (n=34). The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae.ConclusionSpecific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential.

HighlightsWe propose a harmonized set of age bins for assessing risks from chemical exposure.The set of early life age groups will facilitate consistency with recent guidance.The age bins allow results from longitudinal birth cohort studies to be combined.Region-specific exposure factors and monitoring data are needed to apply the bins.

ReviewInternational aid can take on a number of forms. Traditionally, official development aid via governments and global institutions is provided by members of the Development Assistance Committee (DAC) of the Organisation for Economic Cooperation and Development (OECD). Funding through these channels is commonly referred to as DAC funding. It is, however, important to note that various other players are also active in the global aid arena, such as international foundations, non-governmental organisations (NGOs), inter-governmental organisations (INGOs) and private funders. [1,2] There is a global debate on the effectiveness of different implementation models of aid and the eventual measurement of impacts and outcomes on recipient countries and populations. There is much theorising over the intended outcomes of development and, therefore, by implication, what aid aims to achieve. The current focus in discussions around development shows a relatively holistic conception of wellbeing and quality of life, rather than narrowly defined economic measures. [3] There is furthermore an expressed need to understand the desires and intentions of all the parties involved in the aid relationship, from the political/foreign policy intentions of donors to the goals of recipients, and how these intentions and the consequent relationships were formed historically. [4] In the literature on the evolution of approaches to funding there is a trend towards criticism of traditional funding modalities and the promotion rather of more inclusive models of aid, such as South-South Cooperation (SSC), comprising collaboration between partners in the global South, and triangular models, involving development partners supporting Southern collaborations. [1,5] The latter models are thought to have advantages, [6] notably a greater focus on partnerships and co-operation.This article has four broad aims: firstly, to present the evolution of Southern approaches to development co-operation. SSC will be situated historically against the backdrop of aid generally in the post-World War II period. There is a particular theoretical background to the concept of SSC, which is importantly derived from the post-colonial experience of Africa, Latin America and Asia, loosely referred to as the developing world in current discourse. This historical positioning gives rise to a number of criticisms of traditional aid models, from terminology to practice. Secondly, it aims to indicate examples of current co-operative programmes in health and health science education in Africa, which are based on the principles of SSC and triangular aid. Some of these programmes (notably the United States President's Emergency Plan for AIDS Relief (PEPFAR)) have evolved away from strategies based on vertical interventions, and at the time of writing were active in the brokering of co-operative partnerships and the facilitation of 'twinning' relationships.[7] The latter approach is in line with those typical of SSC and triangular models. In a policy document on approaches to coll...

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